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NOTE: Applicant must initial all spaces. Fill in all appropriate blanks, check all a ro riate <br /> boxes. pp p <br /> 1. I have received a copy of the system design including <br /> Septic System Approval Cover Sheet. <br /> e City of Orono <br /> • <br /> .2. I will be installing the following:' <br /> A. Tanks: t Precast Concrete Other Manufacturer <br /> Tank Capacities: 1) / Qal. 2) gal. 3) gat.' <br /> - B. Pump Station (if required) <br /> Pump make & model /4'` • (attach pump curve & <br /> literature); system design requires ` •gpm at 4 feet of head. <br /> High water alarm make & model ti <br /> r Outside <br /> electrical work to be completed by installer electrician <br /> other . Inside electrical work must be completed by <br /> electrician. <br /> • C. Treatment System: <br /> Trenches: s.f. x Mound <br /> Depth of rock below pipe " Rock bed dimensions 'x n ' <br /> Drop Boxes Sand bed dimensions 'x ' <br /> Distribution Box Pressure Dist. Pipe Diam. <br /> .Maniford Pipe Diann. " <br /> D. Final Cover/Topsoil to be: borrowed from site <br /> (show location on site plan)- <br /> V trucked in <br /> The undersigned hereby applies to the City of Orono for issuance of a septic system installation <br /> permit, agrees to do all work in strict accordance with the ordinances of the City and the <br /> regulations of the State of Minnesota, and certifies that all statements made on this application <br /> are complete, true and correct: <br /> SignatureofApplicant: Date: <br /> MPCA Certification No.: •` /,,t - <br /> . <br /> • <br /> Staff Review: Approval Denial • . • <br /> Reviewer: &A--- ' • <br /> Date: g S <br /> Reason for Denial: <br />